Outcomes following adoption of a standardized protocol for abscess drain Management in Pediatric Appendicitis
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Read the article on jpedsurg.org ↗Article · Oct 2020 · 1 min read
In brief
In brief
Implementation of a standardized drain management protocol for complicated pediatric appendicitis reduced interventional radiology procedures by 46% (2.4 to 1.3 per patient) without increasing readmissions or hospital length of stay. The protocol eliminated routine fluoroscopic drain studies in favor of clinical assessment and drain output monitoring, potentially reducing radiation exposure and resource utilization while maintaining patient safety.
Written by the GCMD Library team from the article.
Abstract
Background/purpose
Though evidence-based clinical pathways for the diagnosis and treatment of pediatric appendicitis have been established, protocols guiding management of percutaneous abscess drains are lacking. We hypothesized a drain management protocol utilizing drain output and clinical factors instead of fluoroscopic drain studies would reduce interventional radiologic procedures without adversely impacting clinical outcomes.
Methods
A standardized protocol was uniformly adopted at a tertiary-care children's hospital in April 2016. A retrospective chart review included all cases of appendicitis requiring abscess drainage by interventional radiology three years pre- and postprotocol implementation.
Results
Fifty-eight patients (preprotocol = 39, postprotocol = 19) underwent percutaneous abscess drainage, of whom 52 (preprotocol = 34, postprotocol = 18) required a drain. Baseline demographics and clinical presentation were similar across groups. Following protocol implementation, total number of IR procedures decreased from 2.4 to 1.3 per patient (p = 0.004). There was no significant difference in the number of postprocedure diagnostic imaging studies, readmissions, or inpatient days, and there was a trend towards a decrease in number of drain days (10.7 to 5.7, p = 0.067).
Conclusion
A standardized protocol for management of abscess drains for complicated appendicitis reduced the number of IR procedures without a negative impact on clinical outcomes or increase in alternative imaging studies. This approach may decrease radiation exposure, anesthetic administration, and resource utilization.
Type of study
Treatment study (retrospective comparative study).
Level of evidence
Level III.